tbuckley/cabot-search huggingface dataset:
Exploring the reproductive and sexual health concerns of young adults with cancer.
Authors: Surabhi Menon, Jennifer Levine
Journal: Journal of Clinical Oncology (2023)

e24176 Background: Young adults (YA) with cancer face unique challenges due to their developmental stage at the time of diagnosis/treatment. In the limited number of studies that have looked at reproductive and sexual health among YA being treated for cancer, YA expressed a need for increased communication and guidance in these areas. There is inadequate insight into the extent of sexual and reproductive concerns YA have and the substance of related counseling patients have received in the past, if any. As survivorship rates improve in this age group the need to address reproductive and sexual health as a part of comprehensive cancer care increases. Methods: This was a cross sectional study via a one time survey created on REDCap. Eligibility included diagnosis of malignancy (lymphoma, leukemia, breast cancer, or testicular cancer) between ages 18-39, less than 5 years from therapy completion. Eligible participants were identified via an i2b2 filter on Epic. Enrolled participants completed an online survey that focused on their concerns surrounding sexual health, fertility, contraception, the HPV vaccine, and any counseling they received in those areas. Questions regarding patient demographics, diagnostic, and treatment information were included. Results: The survey was completed by 23 patients (126 eligible, 52 contacted after permission given by the primary oncologist). Patients were 52% female, 73% non-Hispanic/Latino. 57% were between ages 18-24 at diagnosis and the most common cancer for females and males were lymphoma and testicular cancer respectively. 57% of patients stated they had questions about sexual activity during their cancer diagnosis and treatment, 35% recalled having a discussion with a provider. 60% of patients said cancer affected their sex life, with over 80% of those stating it was a net negative effect. 82% of patients had questions about fertility, and 87% had a discussion with a provider. 24% had questions about contraception with 43% having a discussion. 43% of patients were unsure if there was any conversation about the HPV vaccine. Conclusions: YA cancer patients seem to have many questions surrounding sexual and reproductive health. The biggest discrepancy between questions had and conversations had was specifically in the area of sexual health. Future research should delve into the content of the questions and how providers can better address sexual health in a standard manner. Most patients who had questions concerning fertility report they did have some discussion, although satisfaction varies. The majority of patients said cancer negatively affected their sex life, but it is yet to be determined if this affects overall quality of life and if providers can help. The lack of HPV vaccine counseling should be further explored.[Table: see text]
Clinical and pathological correlation of p53expression in oral cancers.
Authors: Venkata Madhavi Bellala, Ravishankar Bellala, Sriharsha Haranadh, Akash Kalagara, Venkateswar Rao P, Kasipeta Sowjanya
Journal: Journal of Clinical Oncology (2023)

e18039 Background: p53 is a tumor suppressor protein, its overexpression is associated with survival and response treatment in squamous cell carcinoma of oral cancers. p53 is detectable on immunohistochemistry in carcinogen associated oral squamous cell carcinoma. The aim of this study is to explore the prevalence of p53 expression and its prognostic importance in oral squamous cell cancers. Methods: This study was conducted at Omega hospital during January to December 2021. One hundred fifty five samples were examined on relationship of p53 expression with clinicopathological correlation with a follow up period of 13 months. All the tissue samples spotted in tissue microarray, were submitted to immunohistochemistry assay for qualitative detection of p53 (Hu). IHC was performed using Ventana R BenchMark Ultra using manual. Results: Overall 58 % were p53 mutant positive and 42% were wild type p53. All 155 patients were staged under AJCC, underwent standard treatment including surgery, chemotherapy and radiotherapy. We observed p53 mutation was more prevalent in high grade tumors with 66.7% and 33.3% of high grade tumors had wild type p53 with p value .047 (Pearson chi-square). Patient with p53 mutant and null had more margin positive disease 76.2% compared to p53 wild type 23.8% with p value 0.17 (Pearson chi-square). Mutant and null V patients presented with advanced T stage compared to wild type 36.7% vs 16.1%, p value .009 (Pearson chi-square), node positive disease 58.1% vs 41.9%. Depth of invasion was observed to be more than 20 mm in p53 null and mutant compared to p53 wild 12.2% vs 3.1% p value .037, extra-nodal extension was more in p53 mutant disease compared to p53 wild type 36.7% vs 10.8% with p value of .000 (1 sided Pearson chi-square). The events like local recurrence and death were 58.1% in mutant vs 41.9% in wild type with p value of 0.67 and local recurrence alone was significant with 10.0% in mutant vs 1.5% in wild type of p53. Conclusions: The p53 mutant and null showed greater distinction in clinical presentation and adverse pathological features. The findings suggest that assessing p53 marker in oral cancers will be able to predict the adverse features. Frozen section should be incorporated into the protocol to potentially achieve negative margins. The local recurrence was significantly more in mutant compared to wild type though the deaths were not statistically significant among the groups could be due to shorter follow up period.
Assessing the translation capabilities of NCI-designated cancer websites with a focus on lung, breast, prostate and ovarian cancers.
Authors: Kolton Smith, Ettaib Elmarabti, Hayley Fried, Colette M. Spaccavento
Journal: Journal of Clinical Oncology (2023)

e18514 Background: The world is becoming more and more dependent on the internet for garnering information. Medicine is no exception, with studies suggesting that 70% of patients will consult the internet to learn more about their health. Considering the diverse population served by the United States healthcare system, it is crucial that information can be accessed by Americans of Limited English Proficiency (LEP). This is especially true when it comes to cancer, a disease affecting hundreds of thousands of LEP Americans each year. National Cancer Institute (NCI)-designated cancer treatment centers represent the cutting-edge treatment facilities in oncology. Americans diagnosed with cancer often turn to the website of the nearest NCI-designated cancer center. Our study provides a snapshot of which NCI-designated cancer center websites provide translation capabilities for patient navigations including appointment scheduling, disease information and treatment for four of the most common types of cancer. Methods: Over the course of 2022, we performed a cross-sectional review of the language and translation services available to patients on each of the 71 NCI-designated cancer center websites with a focus on lung, breast, prostate and ovarian cancers. The primary outcomes included availability of translation services, method of translation (google translator vs. written text vs. telephonic) and number of languages offered. Results: Of the 71 NCI-designated cancer center websites, 15 (21.1%) provide information on prostate, lung, ovarian and breast cancer in languages other than English. Among these, 9 (60%) provide direct translation, 1 redirects the user to the NCI website for cancer information, and 5 offer only language lines. Furthermore, of the 9 cancer centers offering direct translation on their websites, only 6 had 2 or more languages. The most common translation language was Spanish (15/15) followed by Arabic and Chinese (11/15). The availability of translated cancer information on these websites did not correlate with the prevalence of LEP in each state. Analyzing previous NCI website interrogations shows that there has been no increase in the translation capabilities of NCI websites since 2019. Conclusions: One way to improve the quality of care in patients with Limited English Proficiency by improving access to care is to increase language concordant resources. NCI designated cancer center websites are sources of cancer related health knowledge. Our research exemplified that there are areas of opportunity to improve the reachability of these recourses to the LEP population. Increasing language concordant resources acknowledges and addresses one of the barriers to care that interferes with the quality of cancer care for LEP patients, promoting shared health care decision making for better health outcomes in a vulnerable population.
Older adults (OA) in clinical trials: Where are they? Representation of OA in clinical trials conducted at the national cancer institute (NCI) clinical center.
Authors: Giovanni Maria Iannantuono, Nirmal Choradia, James L. Gulley, Fatima Karzai, Charalampos S. Floudas
Journal: Journal of Clinical Oncology (2023)

e18517 Background: Clinical trials are a significant source of evidence for diagnostic and management strategies in cancer patients. Diversity, equity, and inclusion are necessary to provide access to clinical trials and improve care. Despite the increase of OA in the United States (US), OA are still under-represented in clinical trials, with a lack of information on clinical outcomes and safety. The NCI provides oncologic care on research studies conducted at the Clinical Center (CC), the research hospital of the National Institutes of Health (NIH) where third-party payers are neither notified nor invoiced for treatments received. Participants come from all over the US and are primarily referred by their primary oncologists. We sought to evaluate the participation of OA in clinical trials at the NCI-CC. Methods: In this retrospective analysis, OA were defined as participants aged ≥65 years. The demographic data of OA enrolled from 2005 to 2019 were retrieved from the Biomedical Translational Research Information System (BTRIS), the NIH clinical research data repository. Data on the incidence of new cancer diagnoses in the US population for the same period (2005-2019) were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. We compared the proportions of OA enrolled in NCI-CC clinical trials with the corresponding data from SEER program. We further stratified the OA into four age subcategories: from 65 to 69, from 70 to 74, from 75 to 79, and older than 80 years of age. No inferential statistical analyses were performed. Results: A total of 37,326 participants were enrolled from 2005 to 2019 on NCI-CC clinical trials. The number of OA = 7,934 (21.3%). According to the SEER program, 11,017,070 people were diagnosed with cancer from 2005 to 2019, and 5,971,607 (54.2%) were OA. Notably, the proportions of OA enrolled in NCI-CC was lower than the SEER data in all the subcategories. Patients ≥75 years accounted for the most under-represented (Table). Conclusions: OA are under-represented in clinical trials conducted at the NCI-CC from 2005 to 2019, emphasizing the need to “geriatricize” clinical trials. Adaptations of trial design such as expansion of eligibility criteria, utilization of geriatric assessment tools, and inclusion of OA-specific enrollment targets may reduce barriers to enrollment. Outreach initiatives to the oncology community to reinforce the need for increased referral of OA along with incorporation of telehealth for trial screening and assessments could also be considered to expand enrollment and increase the evidence base to guide treatment of OA with cancer. [Table: see text]
Obesity and breast cancer in women under age 40.
Authors: Rabia Cattie, Victoria Chung, Marcia Henry, Matthew Alberti, James Peeples, Helen Yuan, Raina Saxena, Susan Olet, Caitlin Taylor, Melanie Anne Sheen
Journal: Journal of Clinical Oncology (2023)

10536 Background: Obesity is a well-established risk factor for postmenopausal hormone-receptor positive breast cancer (BC). The role of obesity in premenopausal BC, especially in women under the age of 40, is not well understood. Multiple studies have shown a decreased rate of premenopausal BC with increasing body mass index (BMI), notably for estrogen receptor positive tumors. Even though there is an inverse association between obesity and premenopausal BC, it has been suggested that obesity has a negative prognostic role in premenopausal BC. This may be explained if premenopausal obese women develop more aggressive tumors. Obesity is associated with triple negative and Luminal B cancers in premenopausal women. We sought to evaluate the relationship between premenopausal breast cancer and obesity in a diverse patient population. Methods: We assembled a 10-year database of women diagnosed with breast cancer before age 40 in a single health system. Data collected included age at diagnosis, self-identified race, breast cancer subtype, BMI, and stage at diagnosis. The control group was all women under the age of 40 presenting to our health system in the same time period. Stratification analysis was performed using Mantel-Haenszel Risk Estimation. Results: The risk ratio between the standardized estimates of BC patients under 40 with BMI ≤ 30 to BMI &gt; 30 is 0.7924, 95% CI (0.683 – 0.920), P = 0.0022. This implies that young BC patients are more likely to be obese than all young women presenting to our health system. There are more obese Black patients compared to White patients. The effect of obesity on BC diagnosis was more pronounced in Black patients, with a risk ratio of 0.59 compared to 0.96. Conclusions: The data presented here challenge previous research which had shown that obesity seemed to be protective against breast cancer in premenopausal women. Here, we see a statistically significant increase in obesity among young women &lt; 40 years presenting with breast cancer. The increased risk of breast cancer diagnosis was particularly pronounced in obese Black women. Previous studies have had a very low proportion of Black women represented, which may cause underestimation of risk in this patient population. These data suggest that obesity is a risk factor for breast cancer in young women, especially in Black patients. [Table: see text]
Feasibility trial of child care as a therapeutic intervention.
Authors: Jasneet Singh, Mary Lorraine Lopresti, Janine Grigelevich, Don S. Dizon, Mary Anne Fenton
Journal: Journal of Clinical Oncology (2023)

e24196 Background: The incidence rate of cancer among young adults (ages 20-44) has steadily increased over the past decade. Among them, approximately 18% are parents within two years of initial diagnosis. Work as part of our Young Women Surviving support group identified childcare support as an unmet need. We therefore sought to determine the impact of childcare provision on the timeliness of care among young women undergoing chemotherapy for cancer. Methods: We conducted a pilot feasibility study that enrolled a convenience sample inclusive of parents with histologically confirmed invasive breast or gynecologic cancer receiving system chemotherapy and were caring for children 16 years or younger. Following consent, funds were reimbursed for costs related to their preferred childcare resource, including for travel and infusion time. Therapy assessments and an abridged version of the NCCN Distress Thermometer (score ranging from 0-10 with 0 indicating no distress) were administered at each infusion appointment. Feasibility was measured by acceptance of childcare services by &gt; 25% of patients identified as eligible. Results: This study was offered to 26 eligible patients, of which 23 enrolled (88.5%) and 20 have follow-up data. Among study volunteers, 80% were white, 15% were black; Five percent identified as Hispanic or Latino. The median age was 39 years old (range, 31 to 79). The majority of patients (85%) had breast malignancy, while the remaining 15% had gynecological cancers. The median number of treatment events for which babysitting services were paid for were 6 (range, 2-18). Of 19 patients with distress scores, 4 (21%) reported childcare as a stress for them. The median distress score decreased over time, from 5 at first treatment event to a median score of 3 at the eighth event. All participants who completed end of study surveys (16 patients) reported they “agree” or “strongly agree” with the statements “I would participate in child care again” and “Babysitting allowed you to get to your treatment on time.” Over the duration of study, 95% of this cohort did not have any delays in their cancer-directed therapy due to childcare. Conclusions: This is early evidence to suggest providing childcare to patients who are also undergoing chemotherapy is feasible and may be beneficial in improving impact on cancer outcomes and psychological distress. Further studies should include a comparator arm to better clarify the significant of this supportive measure. It is important to continue investigating the impact of supportive services on the quality of life and of care for this unique cohort.
Osimertinib rechallenge in advanced EGFR non-small cell lung cancer patients.
Authors: Natalie F. Uy, Micah Tratt, Keith D. Eaton, Rafael Santana-Davila, Christina S Baik
Journal: Journal of Clinical Oncology (2023)

e21196 Background: Treatment after front line osimertinib (osi) for epidermal growth factor receptor (EGFR) mutated advanced non-small cell lung cancer (NSCLC) remains a clinical challenge. Interval chemotherapy after osi may eradicate clones responsible for EGFR tyrosine kinase (TKI) resistance, which may re-sensitize the tumor to EGFR inhibition. We describe outcomes of metastatic EGFR NSCLC patients who undergo osi rechallenge. Methods: NSCLC patients with confirmed EGFR mutation were retrospectively reviewed from a single institutional database from 1/2010-12/2022. We identified patients who received osi after interval therapy following initial osi progression. Patient characteristics and tumor type were collected via chart review. Response was determined using RECIST 1.1. Results: Seventeen patients with osi rechallenge after initial progression were identified. Median age at time of osi rechallenge was 62 yrs (range 42-73). Patients were predominantly female (n = 11, 65%), white (n = 9, 53%) and Asian (n = 8, 47%), never smokers (n = 13, 77%). Patients had either del19 mutation (n = 10, 59%) or L858R mutation (n = 7, 41%). Twelve patients (71%) received a 1 st or 2 nd generation EGFR TKI (erlotinib n = 10, afatinib n = 2) prior to initial osi; eight patients (47%) had confirmed T790M mutation. Eight patients (47%) had CNS metastases prior to osi rechallenge. Twelve patients (71%) had ECOG 0-1 at time of rechallenge. Patients had a median of 4 (range 2-5) lines of therapy prior to osi rechallenge. Median time between initial osi discontinuation and osi rechallenge was 13.8 months (range 3.2-50.7). In the interim, 17 patients (100%) received chemotherapy, 2 (12%) received immunotherapy monotherapy, 3 (18%) received antibody drug conjugate, and 1 (6%) received TKI. Sixteen patients had follow-up restaging CT scans; 1 died before restaging imaging was obtained. Two patients achieved partial response (PR) (13%), and 6 patients had stable disease (SD) as the best response (38%). Median duration of initial osi was 13.9 months (range 1.9-26.4), and median duration of osi rechallenge was 3.6 months (range 1.0-10.3). Patients who had PR/SD were on osi for 7.5 months (range 2.7-10.3). Ten (59%) patients received osi rechallenge for at least 3 months duration, and 6 (35%) received osi rechallenge for at least 6 months duration. Conclusions: Osi rechallenge is a potential option for advanced EGFR NSCLC patients to obtain disease control at later lines of therapy. Further research is needed to characterize mechanisms of targeted therapy resistance and better select patients who can benefit from EGFR TKI re-exposure.
Predictors of benefit to radiation for oligoprogressive disease in <i>EGFR</i>-mutant metastatic non-small cell lung cancer patients treated with osimertinib.
Authors: Monica F Chen, Jennifer Ma, Mark G. Kris, Daniel Richard Gomez, Helena Alexandra Yu
Journal: Journal of Clinical Oncology (2023)

e21127 Background: While osimertinib has transformed the treatment paradigm of EGFR-mutant lung cancers (EGFR+ LC), all patients inevitably progress. Oligoprogression is a common pattern of progression for which radiation therapy (RT) can be utilized to prolong the time on osimertinib. However, data supporting the benefit of osimertinib in prolonging progression is limited. Furthermore, predictors of response to RT in the setting of oligoprogression are unknown. We aim to identify clinical and genomic factors associated with robust progression-free survival (PFS) after RT for oligoprogression in EGFR+ LC in patients treated with osimertinib. Methods: Patients with metastatic EGFR+ LC on osimertinib who underwent radiation from 2010 to 2022 for oligoprogression (i.e. progression in 5 or less lesions) were identified. Patients received RT to all active sites of intra- and extra- thoracic disease. Patients who progressed within 3 months of radiation therapy were classified as “rapid progressors,” and those that had longer PFS were “late progressors.” All cases underwent clinical and genomic annotation. Comparisons of categorical variables were performed by Fisher’s exact test. Results: 84 patients were identified who underwent RT for oligoprogression on osimertinib, of which 25% (n = 21) were rapid progressors. Median time from radiation to subsequent progression was 6 months (range 1-26mo) and upon progression most patients had growth of more than one lesion (71%). Median time to death or last follow-up was 13.5 months (range 1-48mo). There was no significant difference in gender, ethnicity, and baseline KPS between rapid and late progressors. Patients with baseline exon 19 deletion (63% vs 76%, p = 0.3) and atypical mutations (14% vs 3%, p = 0.1) were more likely to be rapid progressors while those with exon 21 L858R (10% vs 33%, p = 0.03) were more likely to be late progressors. Among the rapid progressors, 50% underwent radiation to the lung, 10% to the brain, 35% to the bone, and 5% to lymph nodes. Median size of the largest lesion and number of lesions was similar between the two groups (rapid 2.5 cm and 1.5 lesions vs late 2.7 cm and 1 lesion). In-field recurrence rate was 18% and did not differ between rapid and late progressors (14% vs 19%). Conclusions: Radiation therapy for oligoprogression results in clinically meaningful time on osimertinib beyond progression for many patients. However, 25% of patients rapidly progress after radiation therapy and should be directed to switch systemic therapy. Further study is needed to better elucidate benefit at the time of radiation, so that the systemic treatment approach for these patients can be optimized.